Provider Demographics
NPI:1841793130
Name:VELAZQUEZ, DANIELA (DC)
Entity Type:Individual
Prefix:
First Name:DANIELA
Middle Name:
Last Name:VELAZQUEZ
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:631 W AVENIDA DE LA MERCED
Mailing Address - Street 2:
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-2626
Mailing Address - Country:US
Mailing Address - Phone:323-805-1859
Mailing Address - Fax:
Practice Address - Street 1:631 W AVENIDA DE LA MERCED
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-2626
Practice Address - Country:US
Practice Address - Phone:323-805-1859
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-13
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36698111N00000X
2255A2300X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
0000OtherAZUSA PACIFIC UNIVERSITY